Sleep Apnea In Children: Types, Signs, Symptoms And Treatment

Never delay evaluation of sleep disturbances and unusual snoring in children.

Medically reviewed by Dr. Dur Afshar Agha, MS Dr. Dur Afshar Agha Dr. Dur Afshar AghaMS facebook_iconinsta_icon Specialty: Masters of Tropical PediatricsExperience: 26 years
Written by Dr Bisny T. Joseph Dr Bisny T. Joseph
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Sleep Apnea In Children: Symptoms, Causes, And Remedies

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Sleep apnea in kids is a common sleep disorder that causes breathing to pause during sleep. Periodical pausing of breathing may occur anytime during sleep, a few times to several times. Sleep apnea may affect sleep quality and cause excessive daytime sleepiness, affecting a child’s productivity and behavior.

The child is partially awake during a breathing pause as their brain wakes from a deep sleep stage to maintain breathing. It disrupts sound sleep, which causes the brain to feel exhausted and drained.

Scroll down to know about the causes, symptoms, risk factors, diagnosis, and treatment of sleep apnea in children.

Types Of Sleep Apnea

Sleep apnea can be of three types (1).

  • Obstructive sleep apnea (OSA): This is the most common form of sleep apnea due to complete or partial blockage of the airway, resulting in absent or decreased breathing during sleep.
  • Central sleep apnea (CSA): This happens when there is a lack of effort to inhale due to the brain failing to signal the respiratory muscles. In such cases, there is no blockage in the airway.
  • Mixed or complex sleep apnea: This is a combination of obstructive and central sleep apnea.

Causes And Risk Factors For Sleep Apnea

Any conditions causing partial or complete airway blockage during sleep could result in obstructive sleep apnea. Risk factors for obstructive sleep apnea in children may include the following (2).

  • Enlarged adenoids and tonsils
  • Obesity
  • Small jaw
  • Overbite (the upper jaw overlaps the lower jaw)
  • Nasal allergies
  • Tongue and throat muscle weakness, especially in children with cerebral palsy and Down syndrome
  • Positive family history
  • Second-hand smoke

Medical conditions affecting the brainstem may result in central sleep apnea in some children. In this case, the brain may temporarily fail to send signals to respiratory muscles to control breathing.

The following conditions may increase the risk of central sleep apnea in children (3).

  • Brain infections
  • Stroke
  • Heart failure
  • Use of opioids or other sedatives
  • Congenital central hypoventilation syndrome; a rare genetic disorder that causes shallow breathing during sleep

Signs And Symptoms Of Sleep Apnea

Snoring is the main symptom of obstructive sleep apnea. However, not all children who snore have sleep apnea. You may hear snoring or choking sounds or a loud gasping when a child takes a deep breath during sleep apnea. Although children with central sleep apnea may snore, it is not a prevalent symptom.

Other signs and symptoms of sleep apnea during sleep may include (4):

  • Choking
  • Coughing
  • Breathing from mouth while sleeping
  • Night sweats
  • Sleep terrors
  • Sleepwalking
  • Talking in sleep
  • Bedwetting

Children with sleep apnea may also experience the following signs and symptoms when awake (4).

  • Concentration issues
  • Daytime sleepiness
  • Headaches in the morning
  • Irritability
  • Behavioral problems, such as ADHD, impulsiveness, and rebelliousness
  • Inability to manage emotions

Sleep apnea can impact the physical and mental wellbeing of a child. You may seek pediatric care to determine the presence of sleep apnea if your child has any of the above-listed symptoms.

Diagnosis Of Sleep Apnea

Doctors may ask the caregivers or parents about the child’s sleep habits, nighttime and daytime symptoms, and health history. Physical examination of the mouth and throat may be done to look for signs of enlarged tonsils or adenoids (5).

Doctors may order polysomnography, a sleep test, if the initial diagnosis suggests sleep apnea. This test is done overnight at a sleep clinic, and it measures specific bodily activities when a person sleeps.

The American Academy of Pediatrics and the American Academy of Sleep Medicine do not recommend home sleep tests to monitor breathing patterns and effort and oxygen saturation for children. These tests will have to be done in a clinical setting to determine the presence of sleep apnea in the child.

Treatment For Sleep Apnea

First-line treatment involves managing the underlying cause of central or obstructive sleep apnea. Treatment may vary depending on the cause and severity of sleep apnea and may include the following measures (6).

  • Adenotonsillectomy: This is the surgical removal of enlarged adenoids and tonsils, curing obstructive sleep apnea.
  • Myofunctional therapy: It is also called oropharyngeal exercises or mouth and throat exercises and may improve snoring and obstructive sleep apnea in some children.
  • Continuous positive airway pressure (CPAP) pumps air into the airway through a pump and mask.
  • Orthodontics approaches, such as maxillary expansion and mandibular advancement devices, use dental appliances to create more space in the mouth to increase the airflow.
  • Medications for sinusitis, tonsillitis, and allergies, including steroid nasal spray, anti-allergens, and saline nasal rinses, may reduce sleep apnea in some children.
  • Bilevel positive airway pressure (BPAP): This also pumps air to the airway like in CPAP but adjusts air level during inhalation and exhalation.
  • Adaptive-servo ventilation (ASV): This device monitors breathing and pumps air according to the requirements.
  • Phrenic nerve stimulation: This is a new FDA-approved therapy for central sleep apnea. In this treatment, the phrenic nerve is stimulated by pacemaker-like devices to control breathing.

Natural Treatments For Sleep Apnea

Children with mild sleep apnea without any specific symptoms are monitored without giving treatments. Doctors may suggest some sleep habits and natural methods to reduce sleep apnea in such cases (6).

  • Weight loss can reduce the risk of sleep apnea in obese children. A pediatrician or a dietician can help plan a healthy diet and exercise regime for your child.
  • Physical therapy, such as nasal breathing retraining or myofunctional therapy, helps the child breathe well.
  • Avoiding allergic substances, such as mold and pollen, may reduce allergic rhinitis, curing sleep apnea over time.
  • Positional therapy teaches the child to sleep in various positions to reduce sleep apnea symptoms.

These treatments are usually recommended for a few children with mild sleep apnea. You may seek medical care to know appropriate treatment for your child.

Can A Child Grow Out Of Sleep Apnea?

Most children with mild symptoms may outgrow this condition. Treatments of underlying causes may cure or improve sleep apnea in a few children. If left untreated, sleep apnea may complicate into the following conditions.

  • Attention deficit disorders
  • Poor academic performance
  • Enuresis (inability to control urination)
  • Behavioral issues
  • Cardiopulmonary problems

When To See A Doctor?

You may seek pediatric care if your child has any symptoms of sleep apnea. Academic and behavioral problems in children also require medical analysis to identify and treat the cause. Pediatricians can evaluate the child and refer to a sleep medicine specialist for detailed evaluation.

Although obstructive sleep apnea is the most prevalent form of sleep apnea in children, most get better with specific treatment. However, many cases of central sleep apnea may require lifelong care. Continuous positive airway pressure may help to manage symptoms of both obstructive and central sleep apnea in children. Seeking early medical care for your child’s sleep apnea symptoms may improve the outcome.

Frequently Asked Questions

1. Can sleep apnea cause learning disabilities?

A study shows that children with persistent sleep apnea are seven times more likely to have learning issues and three times more likely to have lower grades in school (7). However, further research may be needed to validate these findings.

2. Does sleep apnea affect height?

Obstructive sleep apnea may lead to growth retardation in young children. It may be caused by increased exertion due to strained breathing during sleep or decreased appetite due to enlarged tonsils. However, this issue usually resolves once adequate treatment has been obtained (8).

3. Does a humidifier help with sleep apnea?

Higher humidity can increase your comfort while sleeping. Hence, many doctors recommend using a humidifier while undergoing CPAP therapy to increase the effectiveness of the treatment (9).

Untreated sleep apnea could affect the child’s overall well-being as it may hinder their daytime rituals. Hence, if you observe the signs of sleep apnea in children, visit a medical professional for an intervention. You may observe the signs of sleep apnea and note your child’s breathing patterns when asleep to report to their doctor. The treatment plan would depend on the cause. While obstructive sleep apnea may worsen after treatment, central sleep apnea may require life-long care. Follow the doctor’s suggested treatment plan and remedies for a positive outcome. You may also try a few natural remedies on the side after the approval of your physician.

Key Pointers

  • Sleep apnea is classified into obstructive, central, and complex sleep apnea.
  • Snoring, coughing, night sweats, sleep terror are some of the common symptoms of this disorder in children.
  • Obesity, enlarged tonsils, weakness in muscles of tongue and throat may increase the risk of sleep apnea in kids.
  • Treatment is suggested after diagnosis of the underlying reason for the condition.

References

1. What Is Sleep Apnea; American Sleep Apnea Association
2. Obstructive Sleep Apnea; Children’s Hospital of Philadelphia
3. Central Sleep Apnea; Sleep Foundation
4. Obstructive Sleep Apnea In Children; Cedars-Sinai Medical Center
5. Obstructive Sleep Apnea In Children; American Thoracic Society
6. Children and Sleep Apnea; Sleep Foundation
7. Children with sleep apnea have higher risk of behavioral, adaptive and learning problems; American Academy Of Sleep Medicine
8. Yuval Nachalon et al., Inflammation and Growth in Young Children with Obstructive Sleep Apnea Syndrome before and after Adenotonsillectomy; National Library of Medicine
9. The Importance of CPAP Humidification; Sleep Apnea
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Dr. Dur Afshar Agha
Dr. Dur Afshar AghaMS
Dr. Dur Afshar Agha is a consultant pediatrician with around 26 years of experience in various medical facilities both in Pakistan and Saudi Arabia. She has headed the Department of Preventive Pediatrics at the prestigious, Children’s Hospital and Institute of Child Health in Pakistan and is a life member of the Pakistan Paediatric Association.

Read full bio of Dr. Dur Afshar Agha
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